Is Agriculture Really the Best Model for Heath Care?

I always look forward to Atul Gawande's interventions in the Health Care Reform debate, but I'm not so certain about his most recent New Yorker article. Gawande sets out to defend the Senate health bill's apparently disconnected string of minor pilot programs by pointing to some government pilot programs that worked: the federally funded agricultural extension system and a slew of other USDA knowledge-gathering and know-how-distributing apparatuses:

What seemed like a hodgepodge eventually cohered into a whole. The government never took over agriculture, but the government didn’t leave it alone, either. It shaped a feedback loop of experiment and learning and encouragement for farmers across the country. The results were beyond what anyone could have imagined. Productivity went way up, outpacing that of other Western countries. Prices fell by half. By 1930, food absorbed just twenty-four per cent of family spending and twenty per cent of the workforce. Today, food accounts for just eight per cent of household income and two per cent of the labor force. It is produced on no more land than was devoted to it a century ago, and with far greater variety and abundance than ever before in history.

I'll accept Gawande's point about the utility of piecewise reform or even the potentially transformative power of demonstration programs. If the federal government encourages greater diversity in thinking and innovation, so much the better. After all, that's why organizations like the National Science Foundation exist as well.

But does Gawande really want to point to the successes of agriculture to make his point? I don't argue that federal and state support of agricultural research and extension helped transform American agriculture and deserve much credit for the state of American agriculture today. But that support must also share the blame for the serious faults in our current agricultural system.

Leading agricultural scientists in the first decades of the twentieth century set out to increase productivity while also saving small family farms. See Liberty Hyde Bailey on the perils of "Cheap Food" if you don't believe me. Yet the story of American agriculture in the twentieth century has plenty of increased productivity and very little saving of small family farms.

Not only did that, but in the last few decades many have come to realize that other high costs come with modern agriculture: enormous energy demands for machinery and petrochemical fertilizers; near monopolies on food processing; the rise of antibiotic-resistant strains of dangerous bugs.  For that matter, even the truly amazing gains in productivity that Gawande praises appear mixed blessings at best. After all, in many ways the rise of cheap food, led by King Corn-syrup,  has made many Americans less healthy.

Perhaps next time, Gawande will look for a historical model with fewer problems. At the very least, he could do a bit less fervent a sales job and acknowledge those problems for his readers.